Turf Wars

[Hedwig]

So, what are the big turf wars in medicine these days? How do you think they'll be resolved?

---

Members don't see this ad.

 

[meandragonbrett]

These days the BIG one is CRNA v. MDA. I just wish the MDA's would grow up and realize that somebody else can do the same thing as them for cheaper. I'm NOT saying we don't need MDA's. CRNAs can handle a case on their own, unless it's a difficult airway or something like that then have the MDA there to assist or w\e.

brett

I'm sure i'll get flamed for this, but those that do, you know where you can go

 

[windsurfr]

Opthamology (sp?) vs. Optometry as well....

 

[John90210]

There is no cost benefit to having CRNAs do anesthesia. The pay is per procedure, not per provider. i.e. Anesthesia for a knee scope is $427, no matter who does it....

 

[John90210]

PA vs FP, IM, of PEDs is another popular one.

Podiatrist vs. Orthos, believe it or not.

Surgical Assistant, vs Surgeons. Some vascular cases are now being done by Assistant who harvest the lower extremity veins while the MD surgeon is working on the other end. I have seen this personally. (private hosptial in Colorado)

 

[dr.evil]

Possible turf wars exist between vascular surgery and interventional radiology but best results seem to be obtained with a combo of the two.
Overall, it seems the interventional procedures are invading on many of the surgical procedures (cardiology vs. cardiothoracic surgery). This is actually good in the long run so probably not much of a turf war.

 

[godfather]

ent vs oromaxifacial surgery

 

[Sevo]

Some others not mentioned...

ENT (aka now as "head & neck") vs. plastics for facial plastic surgery

ortho vs neuro for spine surgery

anesthesia vs pm&r for invasive pain management

 

[Sevo]

Oh, yeah.

IM vs. FP vs. NP vs. PA for primary care.

FP vs. all the IM specialities vs. derm for various outpatient procedures.

 

[dingiswayo]

invasive cardiology vs. interventional radiology

 

[Winged Scapula]

•••quote:•••Originally posted by John90210:
•
Surgical Assistant, vs Surgeons. Some vascular cases are now being done by Assistant who harvest the lower extremity veins while the MD surgeon is working on the other end. I have seen this personally. (private hosptial in Colorado)•••••Not so unusual, happens rather frequently (at least in CT Surgery) here. Maybe the turf war should be intern vs NP/PA in the CABGs.

 

[Freeeedom!]

The PA thing is most likely blown out of proportion since they work FOR the Doc, and the informed consumer would never choose one of lesser qualifications to take care of primary care (HTN management, DM management etc). Legal issues and the AMA would not let it get that far...Quality is CONSUMER DRIVEN.
As for CRNA vs. MD...that is ridiculous, once again the benefit belongs to the MD, and he/she can charge for the management. Ask a pt who they want at the head of the table, Nurse or Doctor and guess what answer you will get. Plus, I have ALREADY seen 1 death and 2 codes when a CRNA was at the head of the OR table. Zero when the doc was there...and my career has been pretty short thus far.
NP's are a different issue altogether.

Podiatrist vs Orthopod? Nah. There is overlap, but Podiatrists do stuff that orthopods want nothing to do with (junk).

The biggest turf war that I have noticed is RN's vs NP's vs PA's!!! The RN's seem to dislike the NP's and the PA's and NP's struggle for middle-of-the-road stuff. Both PA's and NP's are like "life-long" interns...except they aren't doctors, we all know the respect interns get. The final "word" on the matter is the physician.

 

[neutropeniaboy]

I don't think we've ever called ourselves "head and neck"; maybe we call ourselves head and neck surgeons. Plastics is just a subset of what we do. Nevertheless, facial cosmetics and head and neck reconstruction is something that otolaryngologists may want to share with plastics.

As far as OMFS v. ORLHNS goes, if OMFS wants to do all the mandibular fractures, they can feel free to do so.

Another interesting thing that's a turf battle is otolaryngology v. anesthesia -- anesthesia really can't fiberoptically intubate as well as we can. :wink:
•••quote:•••Originally posted by Sevo:
•Some others not mentioned...

ENT (aka now as "head & neck") vs. plastics for facial plastic surgery

ortho vs neuro for spine surgery

anesthesia vs pm&r for invasive pain management•••••

 

[bbbmd]

What do you guys think of this?

I agree with PM&R vs Anesthesia for pain, but what about...

PM&R vs. Neurology for EMGs and Evoked Potentials
PM&R vs. Cardiology for Cardiac Rehab
PM&R vs. DPT's (new clinical doctorates for PTs) for Physical Medicine??? - Will these guys be taking some of our patients in the future once their new degree is established???

Just something to think about for you PM&R guys!!!

 

[Freeeedom!]

bbbmd,

Virtually EVERY established PT that recieved the therapists degree prior to the onset of the DPT thinks the DPT degree is a JOKE...including myself.
The licensing is the exact same (same test regardless of level), the CME is the same (if required at all!), and the practice acts are the same. The underlying theme is that the REQUIREMENTS are different but NOT the degree. Think of it as a PharmD vs RPH at masters level.
Remember it is a CLINICAL doctorate. There will be NO competition vs PM&R. A PT is a PT is a PT is a PT. It is the experience that matters, not DPT, MPT, MSPT, MScPT, PT behind the name...that only matters to other other PT's. It is another way the APTA shoots itself in the foot...applications are down as well as salaries. No one wants to go to school for 6 years and make 40k to start with a ceiling at 55k.

Ok, I am on a soapbox. Sorry. PM&R is a great and growing field and will slowly grab turf once belonging exclusively to Neurology.

 

[TXRI]

We have to believe that our lengthy education gives us some deeper understanding and broader perspective than our nursing trained colleagues. Our extended education should allow us to think of novel solutions to problems instead of always following an algorithm.

 

[sleepysnapper]

I have to agree with the above post. From what I have seen, the routine things that most M.D.s do can be done well by many other healthcare workers.
Becoming technically competent at most procedures does not require a MD degree.

However, it is when presentations are not typical, in the unusual cases and situations that require a more detailed knowledge of concepts that a medical doctor comes into his/her own. That is the key difference in IMHO. Many may say that a CRNA is equal to an MDA but if you look at the difference in their education background (med school + residency vs. nursing school + working in ICU) there is a true fundamental difference.

Same goes for PA and MD. A PA attends trains for approx 18 months as opposed to 48 months + residency. A PA who has been around for awhile may have the the knowledge gained from experience that may make him/her comfortable managing most patients but that does not replace the fundamental base of knowledge of a medical doctor.

Just ask yourself who would you have perform anesthesia on your loved ones: A CRNA by his/herself or would you like a MDA around just in case things go wrong?

Optometrists place the title "Doctor" with their degree and call themselves "eye doctors" which tends to confuse the general public as many do not know the difference between OMD and optometrist. Optometrists take many of the same basic sciences med students do but they have no experience managing patients medically. In their clinical years, they practice in mostly a office setting. A OMD will have had 3rd/4th year in med school plus a whole year as med/transitional/surgery intern. Would you trust an optometrist to do vision correction (legal in one of the midwestern states) or other eye surgery on you or your family when they have never medically managed a patient? Even if the procedure itself is straight forward, I would never let an optometrist perform an invasive procedure on my eyes. The truth is many fields have non-MD personnel constantly trying to assume more legal rights to do what traditionally was reserved only for MD's. Each has their own organization that constantly fight in the political arena. For example In California, optometrist recently received prescribing rights after lobbying for it for many years. In fact one optometrist in California I know has received training to do Lasik procedures in that midwestern state mentioned above. Why? Because he believes that optometrists will be allowed to perform Lasik in California and other states in the near future! I don't know if that will ever happen but it reflects the mindset of some in these fields.

The truth is that one does not easily appreciate the limits of his/her own training without really knowing what MD training entails. I have known MDAs who were CRNAs earlier in their careers and my medicine resident was once a nurse. They have all told me the biggest difference was the level of understanding they had about the processes going on in their patients. They also said that they did not really appreciate this difference until they became MDs and were on the "other side".

Most of these non-MD personnel serve valuable functions in healthcare. Optometrists do a great job with refraction, picking up many eye disorders, and even detecting systemic diseases through evaluating the eyes. CRNA's and PA's help better utilize manpower with well trained people in patient care. The problem is when these people feel that they are functionally equivalent to MD'S.

The last thing I want to say is that CRNA's often site the fact that they were the ones who started administering anesthesia in this country and that MD's came onto the field later in the U.S. However, the field has become increasingly more complex and scientific the past 100 years. Patient safety has improved dramtically and many new significant contributions were made the last few decades since MDs entered anesthesia. Remember that barbers were some of the first ones to perform surgery...that does not mean they are the most qualified to do that in this day and age!

Sorry if I offended anyone. Please note that my sister-in-law is an optometrist and I am close friends with a CRNA and two PA's.

 

[tBw]

biggest turf war?

Accountants versus doctors silly - over who decides what treatment a patient gets....sad but true

 

[navs]

Hey,

First, eurotrash that was funny and unfortunately seems to be true!!

Now, I am another person who believes there is a role for all these para-MD people in the healthcare delivery in the U.S.

BUT... MDs should be the ones who are the main dispensor of healthcare, shouldn't they?? Why else are they Medical Doctor's then??

MDs are trained for a MUCH longer time then any of these other people to recognize and address complex medical issues. Sure a well trained para-medical person could do the "easy" cases as well, but often u don't know which are the easy and hard cases until it is too late.

CRNA's will undoubtly have a role forever, but with the baby-boomers having a strong voice now and in the future and a surgeon's wish for a MDA, their only chance of working alone is where an MDA would not want to practice, a la Iowa, etc.

Just what I thought.

 

[jargon124]

Gee, with all this talk of people taking over functions that should be performed by docs, I hope and prey my medical degree won't be obsolete in 25 years... <img border="0" title="" alt="[Frown]" src="frown.gif" />

 

[Voxel]

Don't worry the trial lawyers will make sure there will be a need for your MD.

 

[Freeeedom!]

First: What is really funny is that it is virtually only the Med student that worries about these turf wars...The docs look at the PA's and NP's that I have worked with and see them as perpetual Interns that are little "drone bees" and nothing else. Med students become interns, then residents, then attendings. Education pays, baby!

Second: It is good that the new generation of Physicians are realizing the potential hazards of lesser qualified personnel performing patient care and management...hopefully we won't hire people (PA's and NP's) purely for the sake of Greed and to make a larger paycheck for ourselves. The repercussions are far deeper than we believe.

Third: Any good Osteopathic Primary Care Doctor knows that for the OPTIMUM in health and well being, OMT is ALWAYS a consideration...and KNOWBODY DOES THAT BUT THE D.O'S!! So, I ain't worried about a nurse with a certificate to prescribe a Z-pack or Skelaxin!!

Fourth: Physician UNIONIZATION

 

[Teufelhunden]

The turf war that nobody wants to discuss here is the struggle between doctors and <a href="http://www.realultimatepower.net/ninja.htm" target="_blank">ninjas</a>

 

[doughboy]

What about the emergence of Urogynecologists vs. Urologists? Do you think urologists will be a little upset to see their piece of the pie with female bladder problems becoming smaller?

 

[Voxel]

Stating the obvious answer to an obvious question. Anytime one has enchroachment of one field upon another the encroached upon people will get upset.